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Managing Depression, During COVID-19

The office for National Statistics reports on a recent survey of over 3,500 adults in the UK, with more than 1 person in 10 (12.9% to be exact) stating they developed moderate to severe depression symptoms during the Covid-19 pandemic. Figures for the period July 2019 to March 2020 (just before the pandemic took flight) show that 9.7% of British adults were reporting moderate to severe depression symptoms in that time. But, in June 2020 alone, the figure jumped to 19.2% - in other words, almost doubling in magnitude!

Depression is not simply feeling down or unhappy – we all feel like that from time to time. Low mood is but one aspect of depression. When a person is depressed, he or she will also have some combination of problems with sleep, disturbed appetite (either eating too much or too little, or just the wrong kinds of food), problems concentrating, persistent negative thinking, tearfulness, irritability, loss of interest in previously enjoyed activities, social withdrawal and a sense of hopelessness and/or helplessness.

Furthermore, depression very often impacts on our self-esteem and confidence, which can have a knock-on effect on our work life, relationships and outlook on life. Left unmanaged, those who suffer enter a vicious negative cycle, where the problems and their impact begin to feed off one another.

Lockdown, and the worries about infection, have clearly worsened the situation. The Covid period has pushed all of us into a more socially isolated place, and taken away our usual outlets for positive, prosocial activity. Routines have been massively pushed aside, and new demands have been thrust upon us – not least, needing to service the educational, social and activity needs of our children, who have had such long periods out of school. The usual respite structures have been absent. Depression may be mild, moderate or severe in it’s intensity. At the mild-moderate level, people generally manage to function with their daily lives and responsibilities, although they may be far from their normal selves, and not flourishing. At the more severe end, the daily responsibilities of life can become too much to manage – even self-care, the ability to face work responsibilities or attention to one’s children, may become compromised.

Whereas a pandemic situation may be a trigger for depression, other precipitating factors for depression may lie in unresolved issues from earlier life. Life events such as loss of a job, a close loss or bereavement and negative health diagnosis are just some of the factors that can trigger depression, especially when these build on each other.

There is some evidence for family histories of depression, although the degree to which it is transferred genetically or learned through social learning (i.e. what we see, hear and experience from a family member who is depressed whilst growing up) is debatable. It is very likely that both processes occur, in greater or lesser degrees. Sometimes, there is no obvious cause or known reason for depression.

The good news is that depression can be managed and overcome. Psychological approaches such as Cognitive Behaviour Therapy (CBT) have a good evidence base, although other therapies also have a lot to offer – infact, whilst most people find CBT beneficial, some people who don’t can gain more from wider psychotherapeutic approaches, particularly those that are ‘insight oriented’ or ‘interpersonally oriented’.

The NICE guidance is for talking therapies (especially CBT) to be the first port of call, with the possibility of adding medication in the form of an SSRI (which stands for ‘Selective Serotonin Reuptake Inhibitor’). There is considerable evidence that SSRI's reduce depression symptoms through raising self-esteem, lowering anxiety and lifting mood.

There is much evidence for improvements in mood and self-esteem through physical activity. Eating and preparing healthy food and having a balanced structure to the week with predictable patterns and routines is beneficial. Small ‘islands’ of things, events or people to look forward to can assist too, as it reduces feelings of isolation or hopelessness. Completing small, achievable tasks that lend a sense of purpose and fulfllment to the day, can reduce the sense of helplessness and boredom.

There is much to be said about meditative practice, faith-based involvement and activities such as Yoga or Tai Chi. Of course, there is a need to develop some motivation and confidence to start or return to these kinds of methods, so it may not be easy to begin with.

To conclude, Covid-19 has brought about many challenges. Even our front-line staff (and you may be one of them) have been impacted. It’s natural to be feeling strained, but hopefully this article gives some hope about the remedies available, if the depression is becoming a